Variability of scan quality and perfusion density in longitudinal optical coherence tomography angiography imaging.

Background/aims: Optical coherence tomography angiography (OCT-A) images are subject to variability, but the extent to which learning impacts OCT-A measurements is unknown. We determined whether there is a learning effect in glaucoma patients and healthy controls imaged with OCT-A.

Methods: Ninety-one open-angle glaucoma patients and 54 healthy controls were imaged every 4 months over a period of approximately 1 year in this longitudinal cohort study.

Short-term structural and functional changes after airway clearance therapy in cystic fibrosis.

Background: Airway clearance therapy (ACT) with a high-frequency chest wall oscillation (HFCWO) vest is a common but time-consuming treatment. Its benefit to quality of life for cystic fibrosis (CF) patients is well established but has been questioned recently as new highly-effective modulator therapies begin to change the treatment landscape. Xe ventilation MRI has been shown to be very sensitive to lung obstruction in mild CF disease, making it an ideal tool to identify and quantify subtle, regional changes.

Describing angular momentum conventions in circularly polarized optically pumped NMR in GaAs and CdTe.

The physical phenomena governing hyperpolarization through optical pumping of conduction electrons continue to be explored in multiple semiconductor systems. One early finding has been the asymmetry between the optically pumped nuclear magnetic resonance (OPNMR) signals when generated by different circular polarizations (i.e.

Value of 10-2 Visual Field Testing in Glaucoma Patients with Early 24-2 Visual Field Loss.

Purpose: To determine whether the 10-2 test of the Humphrey Field Analyzer detected a higher proportion of abnormal visual fields compared with the 24-2 test in the central 10° of patients with early glaucomatous visual field damage.

Design: Prospective observational study.

Participants: Patients with open-angle glaucoma and healthy control participants.

Discrepancy in Loss of Macular Perfusion Density and Ganglion Cell Layer Thickness in Early Glaucoma.

Purpose: To identify characteristics of patients with early open-angle glaucoma exhibiting greater macular perfusion density (PD) loss compared with macular ganglion cell layer (GCL) thickness loss.

Design: Cross-sectional study.

Methods: Optical coherence tomography (OCT) imaging of the optic nerve head and macula was conducted in patients and healthy control subjects.

Asymmetry analysis of macular optical coherence tomography angiography in patients with glaucoma and healthy subjects.

Background/aims: Quantitative analysis of optical coherence tomography angiography (OCT-A) images requires a reproducible approach that accounts for sectoral loss. The objective of this study was to determine whether an index that accounts for both global (perfusion density, PD) and asymmetric loss of perfusion, rather than PD alone, more reliably measures loss of perfusion in patients with glaucoma.

Methods: We analysed macular OCT-A scans of 95 glaucoma patients and 59 control subjects.

Maximizing Physician-Hospital Alignment: Lessons Learned From Effective Models of Joint Arthroplasty Care.

Background: With recent healthcare reform efforts focusing on rewarding value instead of volume, it has become important for orthopedic surgeons to partner and align with their hospitals. We report our experience in aligning clinical and financial incentives with 6 health systems in our geographic area.

Methods: By managing the entire episode-of-care continuum for total hip and total knee arthroplasty patients, our standardized, evidence-based protocols have improved the quality of care for our joint arthroplasty patients.

An Assessment of the Safety of an Orthopedic Specialty Hospital: A 5-Year Experience.

One of the goals of orthopedic specialty hospitals is to provide safe and efficient care to medically optimized patients. The authors' orthopedic specialty hospital is a physician-owned, 24-bed facility that accommodates a multispecialty orthopedic practice in the areas of spine, hip and knee arthroplasty, shoulder and elbow, sports, foot and ankle, and hand surgery. The purpose of this study was to examine the first 5 years of an institutional experience with an orthopedic specialty hospital and to determine if any procedures were at increased risk of postoperative transfer.

Organizational Structural Design in Spine Care.

For a company to provide high value to its customers, its organization design is critical. As health care transitions to a value-based model, it is critical that spinal care organizations are structured in such a way that they can maximize value to both the patient and the payers. This article will discuss the 3 most common ways that an organization can be structured, and the benefits and problems of each design in spinal care.

Value-based Insurance Design.

The increasing awareness of the scarcity of health care resources is forcing the health care industry to improve quality while lowering the cost. One method by which employers and insurance companies are attempting to do this is with value-based insurance design. In these plans, patients pay a lower amount for certain services that are considered high value and a higher amount for services that are considered low value.

Subglacial discharge at tidewater glaciers revealed by seismic tremor.

Subglacial discharge influences glacier basal motion and erodes and redeposits sediment. At tidewater glacier termini, discharge drives submarine terminus melting, affects fjord circulation, and is a central component of proglacial marine ecosystems. However, our present inability to track subglacial discharge and its variability significantly hinders our understanding of these processes.

The Role of Incentives in Changing the Behavior of Spinal Care Providers: A Primer on Behavioral Economics in Health Care.

As spinal care transitions from individual practitioners working in a volume-based reimbursement system toward multidisciplinary health care organizations working in a population-based model with value-based reimbursement, it is critical that insurance companies, administrators, and spine care provider have a clear understanding of how incentives change physician behavior. This article will introduce the concept of behavior economics, and discuss 9 principles relevant to physician decision-making.

The Service-Profit Chain in Spine Surgery.

Medicine has always been a service industry (as opposed to a manufacturing industry), as there is a shift from volume to value in health care, this point is becoming increasingly important. The delivery of good care extends beyond the technical aspects of performing a complex operation or prescribing the right type of medicine. Intuitively physicians have always understood the value of the physician-patient relationship, and its correlation to a good outcome.

Understanding Business Models in Health Care.

The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.

Understanding Competition in Spine Care.

The changing landscape from volume to value represents a natural transformation in the health care industry. Increasingly provider groups are finding themselves responding to unfamiliar market forces. Whether explicit or implicit, competition is playing a larger role for the sustainability of providers.

Understanding Time-driven Activity-based Costing.

Transitioning to a value-based health care system will require providers to increasingly scrutinize their outcomes and costs. Although there has been a great deal of effort to understand outcomes, cost accounting in health care has been a greater challenge. Currently the cost accounting methods used by hospitals and providers are based off a fee-for-service system.

Innovation in Health Care Delivery.

As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem.

Redesigning Health Care Organizations: The Influence of Government Policy and Methods of Payment.

Over the last 5 years, there has been a growing trend toward consolidation in the health care field. As reimbursement moves from a fee-for-service model to a value-based model, there will be continued pressure on physicians to either be a hospital employee or to be in a large multidisciplinary practice. This is largely due to the Accountable Care Act, which directs payers to utilize population-based cost analyses, rather than an individual patient-based analysis.

The Role of Strategy in Health Care.

Significant changes are occurring in the health care field, and spine surgeons must have an understanding of business strategy if they are going to adapt to the new health care environment. Spine surgeons will be required to demonstrate how their service provides a unique value to their patients or else the patients will obtain care from competitors. Classic methods for demonstrating value such as academic prestige and superior clinical outcomes may no longer be sufficient in the evolving health care field, and surgeons will need to demonstrate a comprehensive and cost-effective treatment algorithm for a diagnosis.

Understanding a Value Chain in Health Care.

As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way.

Managing the Delivery of Health Care: What Can Health Care Learn From the Business Community?

The passage of the Patient Protection and Affordable Care Act in March 2010 has resulted in dramatic changes to the delivery of health care in the United States toward a value-based system. While this is a significant change from the previous model, it presents an opportunity for high-quality health care providers to improve patient outcomes while also increasing revenue. However, those that lack a clear strategy to effectively implement change and communicate the increased value to the patients likely will suffer, regardless of how successful or prestigious they seem today.

In vivo remodelling of vascularizing engineered tissues.

A critical aspect of creating vascularized tissues is the remodelling that occurs in vivo, driven in large part by the host response to the tissue construct. Rather than a simple inflammatory response, a beneficial tissue remodelling response results in the formation of vascularised tissue. The characteristics and dynamics of this response are slowly being elucidated, especially as they are modulated by the complex interaction between the biomaterial and cellular components of the tissue constructs and the host.